Waist circumference, body mass index, and postmenopausal breast cancer incidence in the Cancer Prevention Study-II Nutrition Cohort
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High body mass index (BMI) is an established risk factor for postmenopausal breast cancer. However, less is known about associations with waist circumference. In particular, it is unclear whether a larger waist circumference is associated with risk more than would be expected based solely on its contribution to BMI.
We examined the associations of BMI and waist circumference with risk of postmenopausal breast cancer, with and without mutual adjustment, in the Cancer Prevention Study-II Nutrition Cohort. Analyses included 28,965 postmenopausal women who reported weight and waist circumference on a questionnaire in 1997 and were not taking menopausal hormones.
During a median follow-up of 11.58 years, 1,088 invasive breast cancer cases were identified. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated from multivariable-adjusted Cox proportional hazard regression models. Without adjustment for BMI, a larger waist circumference was associated with higher risk of breast cancer (per 10 cm increase in waist circumference, HR = 1.13, 95 % CI 1.08–1.19). However, adjustment for BMI eliminated the association with waist circumference (per 10 cm HR = 1.00, 95 % CI 0.92–1.08). BMI was associated with risk unadjusted for waist circumference (per 1 kg/m2 HR = 1.04, 95 % CI 1.03–1.05) and adjusted for waist circumference (per 1 kg/m2 HR = 1.04, 95 % CI 1.02–1.06).
Our study of predominantly white women provides evidence that a larger waist circumference is associated with higher risk of postmenopausal breast cancer, but not beyond its contribution to BMI.
- Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of Obesity in the United States, 2009–2010. NCHS Data Brief 82
- Amadou, A, Hainaut, P, Romieu, I (2013) Role of obesity in the risk of breast cancer: lessons from anthropometry. J Oncol 2013: pp. 906495 CrossRef
- Toth, MJ, Tchernof, A, Sites, CK, Poehlman, ET (2000) Menopause-related changes in body fat distribution. Ann N Y Acad Sci 904: pp. 502-506 CrossRef
- Phillips, LK, Prins, JB (2008) The link between abdominal obesity and the metabolic syndrome. Curr Hypertens Rep 10: pp. 156-164 CrossRef
- Huffman, DM, Barzilai, N (2009) Role of visceral adipose tissue in aging. Biochim Biophys Acta.
- Rankinen, T, Kim, SY, Perusse, L, Despres, JP, Bouchard, C (1999) The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord 23: pp. 801-809 CrossRef
- Calle, EE, Kaaks, R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4: pp. 579-591 CrossRef
- Kaaks, R, Noord, PA, Tonkelaar, I, Peeters, PH, Riboli, E, Grobbee, DE (1998) Breast-cancer incidence in relation to height, weight and body-fat distribution in the Dutch “DOM” cohort. Int J Cancer 76: pp. 647-651 CrossRef
- Krebs, EE, Taylor, BC, Cauley, JA, Stone, KL, Bowman, PJ, Ensrud, KE (2006) Measures of adiposity and risk of breast cancer in older postmenopausal women. J Am Geriatr Soc 54: pp. 63-69 CrossRef
- Morimoto, LM, White, E, Chen, Z, Chlebowski, RT, Hays, J, Kuller, L, Lopez, AM, Manson, J, Margolis, KL, Muti, PC, Stefanick, ML, McTiernan, A (2002) Obesity, body size, and risk of postmenopausal breast cancer: the Women’s Health Initiative (United States). Cancer Causes Control 13: pp. 741-751 CrossRef
- Macinnis, RJ, English, DR, Gertig, DM, Hopper, JL, Giles, GG (2004) Body size and composition and risk of postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 13: pp. 2117-2125
- Lahmann, PH, Hoffmann, K, Allen, N, Gils, CH, Khaw, KT, Tehard, B, Berrino, F, Tjonneland, A, Bigaard, J, Olsen, A, Overvad, K, Clavel-Chapelon, F, Nagel, G, Boeing, H, Trichopoulos, D, Economou, G, Bellos, G, Palli, D, Tumino, R, Panico, S, Sacerdote, C, Krogh, V, Peeters, PH, Bueno-de-Mesquita, HB, Lund, E, Ardanaz, E, Amiano, P, Pera, G, Quiros, JR, Martinez, C, Tormo, MJ, Wirfalt, E, Berglund, G, Hallmans, G, Key, TJ, Reeves, G, Bingham, S, Norat, T, Biessy, C, Kaaks, R, Riboli, E (2004) Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC). Int J Cancer 111: pp. 762-771 CrossRef
- Huang, Z, Willett, WC, Colditz, GA, Hunter, DJ, Manson, JE, Rosner, B, Speizer, FE, Hankinson, SE (1999) Waist circumference, waist: hip ratio, and risk of breast cancer in the Nurses’ Health Study. Am J Epidemiol 150: pp. 1316-1324 CrossRef
- Folsom, AR, Kaye, SA, Prineas, RJ, Potter, JD, Gapstur, SM, Wallace, RB (1990) Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol 131: pp. 794-803
- Sonnenschein, E, Toniolo, P, Terry, MB, Bruning, PF, Kato, I, Koenig, KL, Shore, RE (1999) Body fat distribution and obesity in pre- and postmenopausal breast cancer. Int J Epidemiol 28: pp. 1026-1031 CrossRef
- Canchola, AJ, Anton-Culver, H, Bernstein, L, Clarke, CA, Henderson, K, Ma, H, Ursin, G, Horn-Ross, PL (2012) Body size and the risk of postmenopausal breast cancer subtypes in the California Teachers Study cohort. Cancer Causes Control.
- Hu, F (2008) Obesity Epidemiology. Oxford University Press, New York CrossRef
- Calle, EE, Rodriguez, C, Jacobs, EJ, Almon, ML, Chao, A, McCullough, ML, Feigelson, HS, Thun, MJ (2002) The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics. Cancer 94: pp. 2490-2501 CrossRef
- World Health Organization (1994) World Health Organization International classification of diseases tenth revision. In: Manual of the international statistical classification of disease, injuries, and cases of death, 10th rev. edn. WHO, Geneva
- Lear, SA, James, PT, Ko, GT, Kumanyika, S (2010) Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups. Eur J Clin Nutr 64: pp. 42-61 CrossRef
- Xue, X, Kim, MY, Gaudet, MM, Park, Y, Heo, M, Hollenbeck, AR, Strickler, HD, Gunter, MJ (2013) A comparison of the polytomous logistic regression and joint cox proportional hazards models for evaluating multiple disease subtypes in prospective cohort studies. Cancer Epidemiol Biomarkers Prev 22: pp. 275-285 CrossRef
- Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. AICR, Washington, DC
- Palmer, JR, Adams-Campbell, LL, Boggs, DA, Wise, LA, Rosenberg, L (2007) A prospective study of body size and breast cancer in black women. Cancer Epidemiol Biomarkers Prev 16: pp. 1795-1802 CrossRef
- Sellers, TA, Davis, J, Cerhan, JR, Vierkant, RA, Olson, JE, Pankratz, VS, Potter, JD, Folsom, AR (2002) Interaction of waist/hip ratio and family history on the risk of hormone receptor-defined breast cancer in a prospective study of postmenopausal women. Am J Epidemiol 155: pp. 225-233 CrossRef
- Rohan, TE, Heo, M, Choi, L, Datta, M, Freudenheim, JL, Kamensky, V, Ochs-Balcom, HM, Qi, L, Thomson, CA, Vitolins, MZ, Wassertheil-Smoller, S, Kabat, GC (2013) Body fat and breast cancer risk in postmenopausal women: a longitudinal study. J Cancer Epidemiol 2013: pp. 754815
- Suzuki, R, Orsini, N, Saji, S, Key, TJ, Wolk, A (2009) Body weight and incidence of breast cancer defined by estrogen and progesterone receptor status—a meta-analysis. Int J Cancer 124: pp. 698-712 CrossRef
- Ritte, R, Lukanova, A, Berrino, F, Dossus, L, Tjonneland, A, Olsen, A, Overvad, TF, Overvad, K, Clavel-Chapelon, F, Fournier, A, Fagherazzi, G, Rohrmann, S, Teucher, B, Boeing, H, Aleksandrova, K, Trichopoulou, A, Lagiou, P, Trichopoulos, D, Palli, D, Sieri, S, Panico, S, Tumino, R, Vineis, P, Quiros, JR, Buckland, G, Sanchez, MJ, Amiano, P, Chirlaque, MD, Ardanaz, E, Sund, M, Lenner, P, Bueno-de-Mesquita, B, Gils, CH, Peeters, PH, Krum-Hansen, S, Gram, IT, Lund, E, Khaw, KT, Wareham, N, Allen, NE, Key, TJ, Romieu, I, Rinaldi, S, Siddiq, A, Cox, D, Riboli, E, Kaaks, R (2012) Adiposity, hormone replacement therapy use and breast cancer risk by age and hormone receptor status: a large prospective cohort study. Breast Cancer Res 14: pp. R76 CrossRef
- Hvidtfeldt, UA, Gunter, MJ, Lange, T, Chlebowski, RT, Lane, D, Farhat, GN, Freiberg, MS, Keiding, N, Lee, JS, Prentice, R, Tjonneland, A, Vitolins, MZ, Wassertheil-Smoller, S, Strickler, HD, Rod, NH (2012) Quantifying mediating effects of endogenous estrogen and insulin in the relation between obesity, alcohol consumption, and breast cancer. Cancer Epidemiol Biomarkers Prev 21: pp. 1203-1212 CrossRef
- Cust, AE, Stocks, T, Lukanova, A, Lundin, E, Hallmans, G, Kaaks, R, Jonsson, H, Stattin, P (2008) The influence of overweight and insulin resistance on breast cancer risk and tumour stage at diagnosis: a prospective study. Breast Cancer Res Treat.
- Tworoger, SS, Eliassen, AH, Kelesidis, T, Colditz, GA, Willett, WC, Mantzoros, CS, Hankinson, SE (2007) Plasma adiponectin concentrations and risk of incident breast cancer. J Clin Endocrinol Metab 92: pp. 1510-1516 CrossRef
- Nickell, WB, Skelton, J (2005) Breast fat and fallacies: more than 100 years of anatomical fantasy. J Hum Lact 21: pp. 126-130 CrossRef
- Janiszewski, PM, Saunders, TJ, Ross, R (2010) Breast volume is an independent predictor of visceral and ectopic fat in premenopausal women. Obesity (Silver Spring) 18: pp. 1183-1187 CrossRef
- Schautz, B, Later, W, Heller, M, Muller, MJ, Bosy-Westphal, A (2011) Associations between breast adipose tissue, body fat distribution and cardio metabolic risk in women: cross-sectional data and weight-loss intervention. Eur J Clin Nutr 65: pp. 784-790 CrossRef
- Subbaramaiah, K, Howe, LR, Bhardwaj, P, Du, B, Gravaghi, C, Yantiss, RK, Zhou, XK, Blaho, VA, Hla, T, Yang, P, Kopelovich, L, Hudis, CA, Dannenberg, AJ (2011) Obesity is associated with inflammation and elevated aromatase expression in the mouse mammary gland. Cancer Prev Res (Phila) 4: pp. 329-346 CrossRef
- Morris, PG, Hudis, CA, Giri, D, Morrow, M, Falcone, DJ, Zhou, XK, Du, B, Brogi, E, Crawford, CB, Kopelovich, L, Subbaramaiah, K, Dannenberg, AJ (2011) Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila) 4: pp. 1021-1029 CrossRef
- Sun, X, Casbas-Hernandez, P, Bigelow, C, Makowski, L, Joseph Jerry, D, Smith Schneider, S, Troester, MA (2012) Normal breast tissue of obese women is enriched for macrophage markers and macrophage-associated gene expression. Breast Cancer Res Treat 131: pp. 1003-1012 CrossRef
- Rose, DP, Komninou, D, Stephenson, GD (2004) Obesity, adipocytokines, and insulin resistance in breast cancer. Obes Rev 5: pp. 153-165 CrossRef
- Milanese, TR, Hartmann, LC, Sellers, TA, Frost, MH, Vierkant, RA, Maloney, SD, Pankratz, VS, Degnim, AC, Vachon, CM, Reynolds, CA, Thompson, RA, Melton, LJ, Goode, EL, Visscher, DW (2006) Age-related lobular involution and risk of breast cancer. J Natl Cancer Inst 98: pp. 1600-1607 CrossRef
- Waist circumference, body mass index, and postmenopausal breast cancer incidence in the Cancer Prevention Study-II Nutrition Cohort
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